Simple pneumothorax converts to a tension pneumothorax if the lung defect acts as a one way valve, which allows ongoing air leak into pleural space without letting it leak back out. The condition can be rapidly fatal as intra-thoracic pressure rises cause decreased venous return and kinking of great vessels resulting in obstructive shock.

A flail chest is defined as fractures of 2 or more ribs in 2 or more locations. This results in a segment of the chest wall that is no longer in continuity with the rest of the thoracic cage. Paradoxical movement results, the segment moves inwards on inspiration as the rest of the chest expands and outwards on expiration as the rest of the chest deflates.

Respiratory monitoring and support — close monitoring of SaO2, respiratory effort, and ABGs is important as patients tend to gradually deteriorate and may require intubation and mechanical ventilation.

Pericardial tamponade is more common in penetrating thoracic trauma than blunt trauma. As little as 75 mL of blood accumulating in the pericardial space acutely can impair cardiac filling, resulting in tamponade and obstructive shock.

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